Cerebellum Flashcards

1
Q

What are the 4 main functions of the cerebellum?

How is it involved in movement?

A
  • the cerebellum does NOT initiate movement - but it is needed for precise, controlled movements

Functions of the cerebellum:

  1. important motor part of the brain
  2. synergy of movement
  3. maintenance of equilibrium** and **coordination of muscle contractions
  4. contraction of muscles at an appropriate time and with an appropriate force
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2
Q

On what side of the body does the cerebellum act?

A

the cerebellum acts IPSILATERALLY

  • it receives information from muscles on one side of the body, and influences muscles on the same side of the body
  • there may be some crossing over of fibres, but the muscles being coordinated are on SAME side of the body as the cerebellum
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3
Q

How can the superior surface of the cerebellum be identified?

How is it divided into 2 lobes and what forms the most medial part?

A
  • the superior surface can be identified as the cut surface of the midbrain is visible
  • the primary fissure separates the cerebellum into an anterior (smaller) and posterior (larger) lobe
  • the vermis is the most medial aspect of the cerebellum
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4
Q

How can the inferior surface of the cerebellum be identified?

What structure is visible here?

A
  • the inferior surface is visible as the cut surface of the medulla can be seen
  • the cerebellar tonsils are visible on the inferior surface

these are the lowest hanging point of the cerebellum and are in close relationship with the medulla oblongata

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5
Q

How can the ventral surface of the cerebellum be identified?

What key area can only be found here and how can it be identified?

A
  • the ventral surface is identified by the superior, middle and inferior cerebellar peduncles
    • it is only visible once the brainstem has been detached
  • the 3rd lobe of the cerebellum is visible from this view - the flocculonodular lobe
  • this is formed by the flocculus (2) and the nodulus (1)
    • the nodulus is an extension of the vermis onto the ventral surface
  • the flocculonodular lobe is demarcated by the horizontal fissure
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6
Q

What is meant by tonsillar herniation?

A
  • if there is an increase in intracranial pressure, the skull cannot expand so the brain becomes compressed
  • as the brain is compressed, there is herniation through the foramen magnum
  • the cerebellar tonsils are often the first structure to herniate
  • this can lead to compression of the medulla and compromise of its functions
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7
Q

What is the relationship of the cerebellum to the 4th ventricle?

Why is this clinically important and what side effects can be associated with this procedure?

A
  • the posterior aspect of the 4th ventricle is formed by the vermis of the cerebellum
  • this is an important landmark for surgical access to the 4th ventricle
  • splitting of the vermis can lead to:
  1. truncal ataxia
  2. gait disturbances
  3. equilibrium disturbances
  4. nystagmus
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8
Q

What are the cerebellar peduncles?

A
  • they are bundles of white matter fibres that connect the cerebellum to the brainstem
  • they carry both afferent and efferent fibres travelling to and from the cerebellum
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9
Q

What are the afferent and efferent fibres carried by the superior cerebellar peduncle?

A

Afferent:

  • dorsal spinocerebellar tract
  • cuneocerebellar fibres
  • vestibulocerebellar fibres

Efferent:

  • cerebellovestibular fibres
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10
Q

What are the afferent and efferent fibres carried by the middle cerebellar peduncle?

A

Afferents:

  • pontocerebellar fibres

MCP carries AFFERENT fibres ONLY

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11
Q

What are the afferent and efferent fibres carried by the inferior cerebellar peduncle?

A

Afferent:

  • ventral spinocerebellar tract

Efferent:

  • cerebellothalamic fibres
  • cerebellorubral fibres
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12
Q

How can the cerebellum be divided into 3 key functional areas?

A

Vestibulocerebellum (archi):

  • formed by the flocculonodular lobe
  • receives information relating to balance and posture

Spinocerebellum (paleo):

  • formed by most of the anterior lobe and the medial portion of the vermis

Pontocerebellum (neo):

  • this is the largest part of the cerebellum that has evolved the most recently
  • it receives many connections from the pons and is involved in performing fine, coordinated motor movements
    • connections from the pons have originally come from the cortex
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13
Q

What are the 4 central nuclei of the cerebellum?

What is their function?

A
  • there are 4 pairs of nuclei that are embedded within cerebellar white matter:
  • from medial to lateral:
  1. fastigial nucleus
  2. globose nucleus
  3. emboliform nucleus
  4. dentate nucleus
  • the globose and emboliform nuclei make up the interposed nuclei
  • the central nuclei contain cell bodies that are the output sites from the cerebellum
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14
Q

Which of the central nuclei are associated with the different functional lobes of the cerebellum?

What do they connect to?

A

Vestibulocerebellum:

  • contains the fastigial nucleus
  • this connects to the reticular formation and vestibular neurones

Spinocerebellum:

  • contains the interposed nuclei
  • this connects to the red nucleus and the VA & VL nuclei of the thalamus

Pontocerebellum:

  • contains the dentate nucleus
  • this connects to the red nucleus and the VA & VL nuclei of the thalamus

The VA & VL nuclei are those that deal with information regarding motor function

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15
Q

What is this?

A
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16
Q

What are the roles of the vestibulocerebellum?

A
  • it receives ipsilateral information from the vestibular system about balance
  • it regulates balance and eye movements
  • it adjusts muscles and eye movements in response to vestibular stimuli (i.e. changes in balance)
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17
Q

Describe the afferent and efferent pathways to the vestibulocerebellum

A

Afferent pathway:

  • vestibular nuclei in the brainstem receive afferent fibres from the vestibular division of VIII
  • they send vestibulocerebellar fibres to the ipsilateral cerebellum via the inferior cerebellar peduncle (ICP)
  • vestibulocerebellar fibres can do 2 things:
  1. travel directly to the flocculonodular (vestibulocerebellar) cortex
  2. synapse at the fastigial nucleus and then continue to the vestibulocerebellar cortex

Efferent pathway:

  • the cerebellum computes the information and sends cerebellovestibular fibres to the vestibular nuclei via the ICP
  • this information regulates balance and eye movements via the vestibulospinal tract and MLF
18
Q

How are the vestibulospinal tract and MLF involved in regulating balance and eye movements?

A

Vestibulospinal tract:

  • this is involved in coordination of the muscles that maintain equilibrium
  • the lateral VST is associated with the extensor posturing muscles and the medial VST is associated with muscles that can move the neck

MLF:

  • the ascending portion of the MLF connects cranial nerve nuclei that can coordinate eye movements in response to changes in balance
  • the MLF descends with the vestibulospinal tract
19
Q

What would a lesion to the vestibulocerebellum lead to?

A
  1. problems maintaining balance
  2. inaccurate eye scanning
  3. truncal ataxia (inability to stand upright)
20
Q

Complete the summary of the vestibulocerebellum

A
21
Q

What is the role of the spinocerebellum?

A
  • it receives unconscious proprioception from the Golgi organs / muscle spindle
    • this includes level of tension, length of muscle & speed of movement
  • it sends outputs to regulate body and limb movements
  • it influences corticospinal and rubrospinal pathways to adjust muscle tone and execution of movements
22
Q

What are the 3 spinocerebellar tracts and what information do they carry?

A

Dorsal spinocerebellar tract:

  • carries information about unconscious proprioception from below C8

Ventral spinocerebellar tract:

  • carries information about unconscious proprioception from below C8

Cuneocerebellar tract:

  • carries information about unconscious proprioception from C1-C8
    • this is information relating to the upper limb and neck muscles
23
Q

Describe the afferent and efferent pathways of the spinocerebellum

A

Afferent fibres:

  • the spinocerebellum receives afferent fibres from:
  1. dorsal spinocerebellar tract (via ICP)
  2. ventral spinocerebellar tract (via SCP)
  3. cuneocerebellar tract (via ICP)
  • these fibres can do 2 things:
  1. project directly to the spinocerebellar cortex
  2. stop and synapse within the interposed nuclei before continuing to the spinocerebellar cortex

Efferent fibres:

  • the cerebellum processes the information and then sends efferent fibres:

cerebellothalamic fibres (via SCP) travel to the VA / VL nuclei of the thalamus

cerebellorubral fibres (via SCP) travel to the red nucleus of the brainstem

  • the cerebellum influences both the corticospinal and rubrospinal pathways that control muscle tone and execution of movements
24
Q

What is significant about how the cerebellothalamic and cerebellorubral fibres travel?

A
  • they both must cross the midline to reach the contralateral red nucleus / thalamus
  • they need to communicate with pathways that will act on muscles on the SAME side as the cerebellum receiving afferent fibres
25
Q

Describe the pathway of the ventral spinocerebellar tract

A
  • primary afferent fibres from the muscle enter the dorsal aspect of the spinal cord
  • they have their cell bodies within the dorsal root ganglion (DRG)
  • primary fibres synapse with second order neurones within the dorsal horn of the spinal cord
  • the second order neurones rapidly cross the midline via the ventral white commissure to join the ventral spinocerebellar tract on the contralateral side
  • fibres ascend to the level of the midbrain within the contralateral ventral spinocerebellar tract
  • the fibres re-cross the midline via the superior cerebellar peduncle (SCP) to reach the ipsilateral side of the cerebellum
26
Q

Describe the pathway of the dorsal spinocerebellar tract

A
  • primary afferent fibres enter the dorsal aspect of the spinal nerve
  • they have their cell bodies within the dorsal root ganglion (DRG)
  • these fibres project to Clarke’s nucleus (C8-L2) and synapse there
  • second order neurones join the ipsilateral dorsal spinocerebellar tract and ascend to the medulla
  • they pass to the spinocerebellar cortex via the inferior cerebellar peduncle (ICP)
27
Q

Between which levels is Clarke’s nucleus present?

What happens if a proprioceptive fibre enters below this level?

A

C8 - L2

  • any proprioceptive fibre entering below this level must ascend within the spinal cord with the fasciculus gracilis
  • when the fibre reaches L2, it re-enters the grey matter and synapses in Clarke’s nucleus to then ascend via the dorsal spinocerebellar tract
28
Q

Describe the pathway of the cuneocerebellar tract

A
  • primary afferent neurones carry unconscious proprioception information from the upper limb and neck (above C8)
  • they enter the dorsal root of the spinal nerve and have their cell bodies within the DRG
  • they ascend within the ipsilateral cuneate fasciculus to the level of the closed medulla
  • they enter the accessory cuneate nucleus to synpase with the second order neurone
    • this is located laterally to the cuneate nucleus
  • the second order neurone ascends as the cuneocerebellar tract to reach the ipsilateral cerebellum via the inferior cerebellar peduncle (ICP)
29
Q

What would be the result of a lesion to the spinocerebellum?

A
  • reduced muscle tone
  • gait ataxia
  • loss of coordination whilst walking
30
Q

Complete for the spinocerebellum:

A
31
Q

What are the roles of the pontocerebellum?

A
  • it receives information about intended movement from the cerebral cortex
  • it is involved in the control of fine motor skills and targeted movements
  • it ensures a smooth and orderly sequence of muscle contractions with intended precision, force and direction
    • this is particularly important for upper limb activities
32
Q

What are the different fibres that travel from the cortex to the pons that have a relationship to the pontocerebellum?

A
  • corticopontine fibres travel via the internal capsule to the pontine nuclei
  • frontopontine fibres travel via the anterior limb of the internal capsule
  • parietopontine fibres travel via the posterior limb of the internal capsule
  • occipitopontine fibres travel via the retrolenticular limb of the internal capsule
  • temporopontine fibres travel via the sublenticular limb of the internal capsule
  • the pontine nuclei then project to the cerebellum via pontocerebellar fibres
33
Q

Describe the afferent and efferent fibres associated with the pontocerebellum

A

Afferent fibres:

  • the pontocerebellum receives afferent pontocerebellar fibres from the contralateral pontine nucleus via the middle cerebellar peduncle (MCP)
  • the pontocerebellar fibres can do 2 things:
  1. travel directly to the pontocerebellar cortex
  2. synapse at the dentate nucleus and then continue to the pontocerebellar cortex

Efferent fibres:

  • the cerebellum computes the information and then sends efferent fibres:

cerebellothalamic fibres travel to the contralateral VA / VL nuclei of the thalamus

cerebellorubral fibres travel to the contralateral red nucleus of the midbrain

they both travel via the superior cerebellar peduncle (SCP)

34
Q

How can the pontocerebellum exert an effect via fibres travelling from the thalamus and red nucleus?

A

Thalamus:

  • fibres from the thalamus project to the motor cortex to exert an influence over the corticospinal tract

Red nucleus:

  • fibres from the red nucleus are able to influence the rubrospinal tract

The pontocerebellum influences descending pathways to ensure intended movements are precise via corticospinal, rubrospinal & reticulospinal tracts

35
Q

What would be the result of a lesion to the pontocerebellum?

A
  • incoordination of voluntary movements
  • intention tremor
  • overshooting
  • reduced accuracy of reaching (clumsy finger to nose) / dysmetria
36
Q

Complete the summary of the pontocerebellum

A
37
Q

What areas of the cerebellum tend to be implicated in midline lesions?

What is the main symptom and most common cause?

A
  • tends to affect the vermis and vestibulocerebellum
  • most common cause is tumours of the IVth ventricle
    • e.g. medulloblastomas in children
  • the main symptom is truncal ataxia
    • this is the inability to stand upright without support
38
Q

What are the symptoms resulting from a midline lesion affecting the pathway from the vermis to the vestibular nuclei?

A
  • malfunction of the lateral vestibular nucleus and vestibulospinal tract can lead to deficient antigravity function

the patient will fall towards the more affected side when attempting to stand or walk

  • nystagmus can be elicited on tracking of a finger from side to side

scanning eye movements are inaccurate due to poor control of the gaze centres by the vermis

39
Q

Which part of the cerebellum tends to be affected in anterior lobe lesions?

Who tends to be affected by these lesions?

A
  • anterior lobe lesions tend to affect the spinocerebellum
  • disease of the anterior lobe is commonly seen in alcoholics
40
Q

What are the symptoms of an anterior lobe lesion?

A
  • the main symptom is gait ataxia
    • a drunken, staggering gait is observed even when the patient is sober
  • tendon reflexes may be diminished in the lower limbs
    • due to loss of stimulation of neurones from the pontine reticulospinal tract
41
Q

What structures can be implicated in a neocerebellar lesion?

What is the main symptom?

A
  • lesion can be located within the superior cerebellar peduncle, neocerebellar cortex or dentate nucleus
  • the main symptom is incoordination of voluntary movements
  • the upper limb is most noticeably affected
42
Q

What are other symptoms / signs of a neocerebellar lesion?

A
  • intention tremor occurs when a fine purposive movement is attempted
  • overshooting / past-pointing occurs when the hand passes the target
  • dysdiadochokinesia occurs when rapid alternating movements performed under command become irregular
    • e.g. finger to nose / alternating pronation & supination
  • phonation and articulation of speech may be affected